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Santamaría-Gadea A, Mariño-Sánchez F, Arana-Fernández B, Mullol J, Alobid I. Innovative Surgical Techniques for Nasal Septal Perforations: Management and Treatment. Curr Allergy Asthma Rep 2021; 21:17. [PMID: 33666791 DOI: 10.1007/s11882-021-00992-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review and describe the main innovative surgical techniques for nasal septal perforation (NSP) repair that have been published in recent years. RECENT FINDINGS Several techniques for NSP repair have been developed recently. The anterior ethmoidal artery (AEA) flap is a versatile technique for middle-size perforations in different locations. The greater palatine artery (GPA) flap is an excellent option for anterior-most NSPs. The lateral nasal wall flap and the pericranial flap are the most appropriate techniques for large perforations. The advent of these techniques has changed the management and has expanded the therapeutic arsenal to treat all types of NSPs according to the size, location, and osteo-cartilaginous support. However, no technique has been accepted as the gold standard. Extensive knowledge of different techniques is important to individualize the treatment, selecting the most appropriate in each case.
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Affiliation(s)
- Alfonso Santamaría-Gadea
- Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Franklin Mariño-Sánchez
- Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramón y Cajal University Hospital, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Beatriz Arana-Fernández
- Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Joaquim Mullol
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Rhinology and Skull Base Unit, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain
| | - Isam Alobid
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- Rhinology and Skull Base Unit, Otorhinolaryngology Department, Hospital Clinic, Universitat de Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain.
- Centro Médico Teknon, Barcelona, Spain.
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Abstract
PURPOSE Nasal septal perforation (NSP) consists of defects of mucosa, cartilage, and bone. Nasal septal surgery is by far the most common cause of NSP. Many surgical approaches have been described for NSP repair. In this study, the authors describe a novel technique for repairing all sizes of NSP using an only fascia lata graft. METHODS The authors implemented a retrospective study design. Seventeen patients who underwent NSP repair between January 2016 and January 2019 were included to the study. Entire nasal surgical steps were performed under endoscopic view, harvested fascia lata graft is placed in tympanoplasty fashion after all edges of perforation is elevated and implantation bed is prepared. RESULTS The mean size of the septal peforations were 18.52 ± 4.17 mm horizontally, 11.52 ± 3.42 mm vertically. The mean follow up period was 14.47 ± 9.5 months (range: 2-36). In 15 of the 17 patients, total NSP closure was achieved (88,23%). CONCLUSIONS Endoscopic close technique using fascia lata for nasal septal perforation closure is a safe and reliable technique with high success rate and it should be considered in patients with nasal septal perforation.
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Mariño-Sánchez F, Santamaría-Gadea A, Vaca M. Technique to Repair a Septal Perforation Endoscopically with a Greater Palatine Artery Pedicled Flap. Facial Plast Surg Aesthet Med 2020; 22:301-303. [PMID: 32101480 DOI: 10.1089/fpsam.2020.0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Franklin Mariño-Sánchez
- Rhinology and Skull Base Surgery Unit, Department of Otorhinolaryngology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Alfonso Santamaría-Gadea
- Rhinology and Skull Base Surgery Unit, Department of Otorhinolaryngology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Miguel Vaca
- Rhinology and Skull Base Surgery Unit, Department of Otorhinolaryngology, Ramón y Cajal University Hospital, Madrid, Spain
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Langdon C, Yuen-Ato K, Pereira-Perez C, Arancibia C, Alobid I. Anterior Pedicled Lateral Nasal Wall Flap for Endonasal Lining: A Radiologic and Anatomical Study. Laryngoscope 2020; 131:E1462-E1467. [PMID: 33140865 DOI: 10.1002/lary.29231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this radiological/anatomical study was to evaluate the feasibility of a new endoscopic technique that uses the anterior pedicled lateral nasal flap (APLNW) for the endonasal lining in complex nasal reconstructions. STUDY DESIGN An anatomical study was performed on 20 nasal fossae of cadaverous specimens to measure the area and lengths of the anterior pedicled nasal lateral wall flap. In addition, a radiological analysis with computed tomography was performed in 150 nostrils to determine the potential donor of the simple and extended flap in the nasal fossa floor. Complex nasal reconstruction with nasofrontal flap and internal lining using the lateral wall pedicled flap was performed in 3 patients. RESULTS Complete reconstruction for the inner lining of the nasal tip and lateral nasal wall was achieved in the cadaveric study (10 specimens). The surface areas of the simple and extended APLNW flaps were 7.53 (standard deviation [SD] 1.25) cm2 and 24.6 (SD 3.14) cm2 , respectively. Using computed tomography scans, we determined that to reconstruct defects secondary to full-thickness nasal defects, the APLNW flap surface for the simple and extended versions was 7.90 (SD 1.68) cm2 and 23.64 (SD 4.7) cm2 . We present one case were the APLNW flap was used. CONCLUSIONS The simple or expanded APLNW flap represents a feasible option to reconstruct the internal lining in complex nasal reconstruction. LEVEL OF EVIDENCE NA Laryngoscope, 131:E1462-E1467, 2021.
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Affiliation(s)
- Cristóbal Langdon
- Rhinology Unit and Skull Base, Department of Otorhinolaryngology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research on Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Kathy Yuen-Ato
- Department of Otorhinolaryngology, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Carla Pereira-Perez
- Department of Otorhinolaryngology, Barros Luco Trudeu Hospital, Santiago, Chile
| | - Claudio Arancibia
- Rhinology Unit and Skull Base, Department of Otorhinolaryngology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Isam Alobid
- Rhinology Unit and Skull Base, Department of Otorhinolaryngology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centre for Biomedical Research on Respiratory Diseases (CIBERES), Barcelona, Spain
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Lavigne P, Vega MB, Ahmed OH, Gardner PA, Snyderman CH, Wang EW. Lateral nasal wall flap for endoscopic reconstruction of the skull base: anatomical study and clinical series. Int Forum Allergy Rhinol 2020; 10:673-678. [PMID: 32104970 DOI: 10.1002/alr.22534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/09/2019] [Accepted: 12/26/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The lateral nasal wall (LNW) flap provides vascularized endonasal reconstruction primarily in revision surgery. Although the harvesting technique and reconstructive surface have been reported, the arterial supply to the LNW flap and its clinical implications is not well defined. This study presents anatomical dissections to clarify the vascular supply to this flap, and the associated clinical outcomes from this reconstructive technique. METHODS The course and branching pattern of the sphenopalatine artery (SPA) to the LNW were studied in 6 vascular latex-injected heads (11 LNW flaps total). Patients undergoing an LNW flap since 2008 were identified and the underlying pathology, indication, flap viability, and clinical outcomes were retrospectively analyzed. RESULTS The inferior turbinate artery arises from the LNW artery and divides into 2 branches at the most posterior aspect of the inferior turbinate bone. A smaller-caliber superficial branch travels anteriorly and branches to the LNW. A larger dominant branch travels into the inferior meatus and tangentially supplies the nasal floor. Twenty-four patients with sellar or posterior cranial fossa (PCF) defects were reconstructed with an LNW flap. Postoperative contrast enhancement of the LWN flap was identified in 95.5% of cases. Postoperative cerebrospinal fluid (CSF) leaks were identified in 6 cases. CONCLUSION Blood supply to the nasal floor by the dominant inferior meatus branch is more robust than the supply to the anterior LNW by the superficial arterial branch. The LNW flap is the preferred vascularized reconstructive option to the PCF and sella in the absence of a nasoseptal flap (NSF).
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Affiliation(s)
- Philippe Lavigne
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Maria Belen Vega
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Omar H Ahmed
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eric W Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Cavada MN, Orgain CA, Alvarado R, Sacks R, Harvey RJ. Septal Perforation Repair Utilizing an Anterior Ethmoidal Artery Flap and Collagen Matrix. Am J Rhinol Allergy 2018; 33:256-262. [PMID: 30525903 DOI: 10.1177/1945892418816959] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nasal septal perforation repair remains a challenge with no standard technique for repair recognized. OBJECTIVE To describe the combination of an anterior ethmoidal artery flap with a collagen matrix inlay as a successful technique for nasal septal perforation repair. METHODS A case series of consecutive patients who underwent nasal septal perforation repair with an anterior ethmoidal artery flap with an inlay collagen graft was conducted. Demographic data, preoperative features of the perforation (size, location, and presence of chondritis), and postoperative outcomes were analyzed; closure rate, mucosalization rate (of the contralateral side at 21 and 90 days), and complications (crusting, bleeding, obstruction, infection, and rehospitalization <30 days) were documented. RESULTS Thirteen patients (age: 49 ± 15 years, 30.8% women) were assessed. The perforation size was 1.6 ± 0.9 cm (range: 0.3-3.5 cm) and located 1.2 ± 0.5 cm (range: 0.5-2.0 cm) posterior to the columella. Chondritis was present in 69.2%. The closure rate was 100% (95% confidence interval [CI]: 77%-100%) at both 21 and 90 days. One patient required a free mucosa graft to an area of persistent crusting on the contralateral side (7.7%). Complications were low; bleeding 0%, obstruction 7.7% (requiring corticosteroid injection of anterior ethmoidal artery flap), and 0% infection/rehospitalization. CONCLUSION Anterior ethmoidal artery flap with an inlay collagen matrix is a reliable technique to repair nasal septal perforation. This technique, with robust vascularity and wide angle of rotation, enables the closure of perforations both large (<50% total septum) and with anterior locations.
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Affiliation(s)
- Marina N Cavada
- 1 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,2 Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Carolyn A Orgain
- 2 Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- 2 Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Raymond Sacks
- 1 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,2 Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,3 Faculty of Medicine, University of Sydney, Sydney, Australia.,4 Department of Otolaryngology, Concord General Hospital, Sydney, Australia
| | - Richard J Harvey
- 1 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,2 Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
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Alobid I, Langdon C, López‐Chacon M, Enseñat J, Carrau R, Bernal‐Sprekelsen M, Santamaría A. Total septal perforation repair with a pericranial flap: Radio‐anatomical and clinical findings. Laryngoscope 2018; 128:1320-1327. [DOI: 10.1002/lary.26966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/12/2017] [Accepted: 09/25/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Isam Alobid
- Rhinology and Skull Base Unit, Department of OtorhinolaryngologyHospital Clinic, University of BarcelonaBarcelona Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS)Barcelona Spain
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES)Madrid Spain
| | - Cristóbal Langdon
- Rhinology and Skull Base Unit, Department of OtorhinolaryngologyHospital Clinic, University of BarcelonaBarcelona Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS)Barcelona Spain
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES)Madrid Spain
| | - Mauricio López‐Chacon
- Rhinology and Skull Base Unit, Department of OtorhinolaryngologyHospital Clinic, University of BarcelonaBarcelona Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS)Barcelona Spain
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES)Madrid Spain
| | - Joaquim Enseñat
- Department of NeurosurgeryHospital Clinic, University of BarcelonaBarcelona Spain
| | - Ricardo Carrau
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES)Madrid Spain
- Department of Otolaryngology–Head and SurgeryThe Ohio State University Wexner Medical CenterColumbus Ohio U.S.A
| | - Manuel Bernal‐Sprekelsen
- Rhinology and Skull Base Unit, Department of OtorhinolaryngologyHospital Clinic, University of BarcelonaBarcelona Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS)Barcelona Spain
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES)Madrid Spain
| | - Alfonso Santamaría
- Rhinology and Skull Base Unit, Department of OtorhinolaryngologyHospital Clinic, University of BarcelonaBarcelona Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS)Barcelona Spain
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES)Madrid Spain
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Alobid I. Endoscopic Closure of Septal Perforations. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dolci RLL, Todeschini AB, Santos ARLD, Lazarini PR. Endoscopic endonasal double flap technique for reconstruction of large anterior skull base defects: technical note. Braz J Otorhinolaryngol 2018; 85:427-434. [PMID: 29754975 PMCID: PMC9443032 DOI: 10.1016/j.bjorl.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/19/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction One of the main concerns in endoscopic endonasal approaches to the skull base has been the high incidence and morbidity associated with cerebrospinal fluid leaks. The introduction and routine use of vascularized flaps allowed a marked decrease in this complication followed by a great expansion in the indications and techniques used in endoscopic endonasal approaches, extending to defects from huge tumours and previously inaccessible areas of the skull base. Objective Describe the technique of performing endoscopic double flap multi-layered reconstruction of the anterior skull base without craniotomy. Methods Step by step description of the endoscopic double flap technique (nasoseptal and pericranial vascularized flaps and fascia lata free graft) as used and illustrated in two patients with an olfactory groove meningioma who underwent an endoscopic approach. Results Both patients achieved a gross total resection: subsequent reconstruction of the anterior skull base was performed with the nasoseptal and pericranial flaps onlay and a fascia lata free graft inlay. Both patients showed an excellent recovery, no signs of cerebrospinal fluid leak, meningitis, flap necrosis, chronic meningeal or sinonasal inflammation or cerebral herniation having developed. Conclusion This endoscopic double flap technique we have described is a viable, versatile and safe option for anterior skull base reconstructions, decreasing the incidence of complications in endoscopic endonasal approaches.
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Affiliation(s)
- Ricardo Landini Lutaif Dolci
- Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil.
| | - Alexandre Bossi Todeschini
- Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas, Departamento de Cirurgia, Disciplina de Neurocirurgia, São Paulo, SP, Brazil
| | - Américo Rubens Leite Dos Santos
- Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas, Departamento de Cirurgia, Disciplina de Neurocirurgia, São Paulo, SP, Brazil
| | - Paulo Roberto Lazarini
- Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
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Abstract
PURPOSE OF REVIEW Nasal septum perforation (NSP) is a communication between the two nasal cavities. This review contributes to the better knowledge of NSP causes, diagnosis, and treatment. RECENT FINDINGS NSP prevalence is about 1%. Clinical presentation may range from absence of symptoms to the presence of bothersome sinonasal symptoms. NSP is more frequently caused by trauma or post-surgery, inflammatory diseases, and abuse substances. Conservative management (nasal irrigation, topical use of antibiotic or lubricant ointments, or placement of prosthesis) is considered the first-line treatment. Symptomatic NSP not improving with local therapies usually requires surgical approach. Selection of the technique for the endoscopic septal repair depends on perforation characteristics and surgeon experience. When NSP is diagnosed, its cause has to be promptly determined. Most of them can be controlled with conservative measures. Surgical/endoscopic approaches are usually needed in refractory cases, and new repair techniques have to be considered.
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Santamaría A, Langdon C, López-Chacon M, Cordero A, Enseñat J, Carrau R, Bernal-Sprekelsen M, Alobid I. Radio-anatomical analysis of the pericranial flap "money box approach" for ventral skull base reconstruction. Laryngoscope 2017; 127:2482-2489. [PMID: 28322453 DOI: 10.1002/lary.26574] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/27/2017] [Accepted: 02/09/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the versatility of the pericranial flap (PCF) to reconstruct the ventral skull base, using the frontal sinus as a gate for its passage into the sinonasal corridor "money box approach." STUDY DESIGN Anatomic-radiological study and case series. METHODS Various approaches and their respective defects (cribriform, transtuberculum, clival, and craniovertebral junction) were completed in 10 injected specimens. The PCF was introduced into the nose through the uppermost portion of the frontal sinus (money box approach). Computed tomography (CT) scans (n = 50) were used to measure the dimensions of the PCF and the skull base defects. The vertical projection of the external ear canal was used as the reference point to standardize the incisions for the PCF. RESULTS The surface area and maximum length of the PCF were 121.5 ± 19.4 cm2 and 18.3 ± 1.3 cm, respectively. Using CT scans, we determined that to reconstruct defects secondary to transcribriform, transtuberculum, clival, and craniovertebral approaches, the PCF distal incision must be placed respectively at -3.7 ± 2.0 cm (angle -17.4 ± 8.5°), -0.2 ± 2.0 cm (angle -1.0 ± 9.3°), +5.5 ± 2.3 cm (angle +24.4 ± 9.7°), +8.4 ± 2.4 cm (angle +36.6 ± 11.5°), as related to the reference point. Skull base defects in our clinical cohort (n = 6) were completely reconstructed uneventfully with the PCF. CONCLUSIONS The PCF renders enough surface area to reconstruct all possible defects in the ventral and median skull base. Using the uppermost frontal sinus as a gateway into the nose (money box approach) is feasible and simple. LEVEL OF EVIDENCE NA. Laryngoscope, 127:2482-2489, 2017.
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Affiliation(s)
- Alfonso Santamaría
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Cristóbal Langdon
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Mauricio López-Chacon
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Arturo Cordero
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ricardo Carrau
- Department of Otolaryngology-Head and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Manuel Bernal-Sprekelsen
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain.,Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain.,Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain
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Chibbaro S, Cebula H, Aldea S, Baussart B, Tigan L, Todeschi J, Romano A, Ganau M, Debry C, Servadei F, Proust F, Gaillard S. Endonasal Endoscopic Odontoidectomy in Ventral Diseases of the Craniocervical Junction: Results of a Multicenter Experience. World Neurosurg 2017; 106:382-393. [PMID: 28676464 DOI: 10.1016/j.wneu.2017.06.148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/20/2017] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Over the past decades, supported by preliminary anatomic and clinical studies exploring its feasibility and safety, experience has increased of the use of the endoscopic endonasal approach (EEA) to ventral diseases at the craniocervical junction (CCJ). METHODS A multicenter study was carried out over a 4-year period of 14 patients managed by EEA odontoidectomy for CCJ diseases causing irreducible atlantoaxial dislocation. The surgical setup included an IGS system based on computed tomography and magnetic resonance images fusion, and 0° and 30° angled endoscopes with dedicated endoscopic tools. RESULTS Nine men and 5 women, with a mean age of 60.7 years, were included. The mean follow-up was 28.5 months; 9 patients had basilar impression, whereas 5 had a degenerative pannus. The quality of anterior decompression was excellent in all cases; nonetheless, a posterior stabilization was deemed necessary in 13 patients, and no external orthosis was used during the postoperative course. No tracheostomy or gastrostomy was required after surgery; no deaths, no new neurologic deficits/complications, and no postoperative cerebrospinal fluid leak were recorded. At follow-up, the neurologic status assessed with Frankel grade did not deteriorate in any of the patients but improved in 13 of them; and no new listhesis was shown on neuroradiologic follow-up. CONCLUSIONS The results show that EEA provides a direct surgical corridor to the CCJ, allowing an adequate decompression as with the more invasive transoral route. Morbidity is less than with a transoral approach, resulting in higher patient comfort and faster recovery.
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Affiliation(s)
- Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France.
| | - Helene Cebula
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Sorin Aldea
- Department of Neurosurgery, Foch Hospital, Suresnes (Paris), France
| | | | - Leonardo Tigan
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Julien Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Antonio Romano
- Department of Neurosurgery, Parma University Hospital, Parma, Italy
| | - Mario Ganau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Christian Debry
- Department of ENT, Strasbourg University Hospital, Strasbourg, France
| | - Franco Servadei
- Department of Neurosurgery, Parma University Hospital, Parma, Italy
| | - Francois Proust
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
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Alobid I. Endoscopic closure of septal perforations. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:165-174. [PMID: 28554559 DOI: 10.1016/j.otorri.2017.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/12/2017] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The management of septal perforations is a challenge for the surgeon. A wide variety of surgical techniques have been described, with different approaches. There is no scientific evidence to support a particular approach. The objective of this review is to present a practical guide on the technique of choice for each case of septal perforation. DISCUSSION Inspection of the nasal mucosa, the size of the perforation, the location and especially the osteo-cartilaginous support, are the pillars of a successful surgery. For the sliding or rotating flaps of the mucosa of the septum it is essential to know in advance if the elevation of the mucopericondrio or mucoperiosteo of the septum is possible, otherwise the use of these flaps would not be indicated. The flaps of the lateral wall or nasal floor are the alternative. The pericranial flap may be indicated in total or near total perforations. CONCLUSION The remnant of the nasal septum and status of osteo-cartilaginous support are the determining factors in the management of septal perforations. Each case should be evaluated individually and the approach chosen according to the size and location of the perforation, mucosal quality, personal history, previous surgery and the experience of the surgeon.
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Affiliation(s)
- Isam Alobid
- Unidad de Rinología y Base de Cráneo, Departamento de ORL, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España.
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